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Networks Indoor Cricket Centre Consent Form
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Please enable JavaScript in your browser to complete this form.
Participant Name
*
First
Last
Participant DOB
*
About Number Select
Participant Age
*
7
8
9
10
11
12
13
14
15
16
Parent / Guardian Name
*
First
Last
Contact Number
*
Email
*
Home Adress
*
Club Name
*
Shirt Size
*
9-11
12-13
Small
Meduim
Large
XL
Please Select – Main Skill
*
Batting
Bowling
Fielding
Keeping
Please Select – Second Best Skill
*
Batting
Bowling
Fielding
Keeping
About You !
*
Medical conditions or allergies?
*
Is there anything else you think we should know?
*
I, undersigned, agree with the following statements:
I Understand that this Consent for is valid for SIX(6) MONTHS and i will inform Networks indoor cricket centre of any Changes
I am the participant or parent/guardian of the participant of the activity specified above.
I understand that participation in this activity involves the risk of personal injury, including death, due to the physical, mental, and emotional challenges in the activities offered.
I understand that participation of this activity is voluntary and I understand that it requires participants to follow instructions and abide by all applicable rules and the standards of conduct.
I am giving my consent in case of an emergency involving my child, and in the event I cannot be reached, medical provider can secure proper treatment, including hospitalisation, anaesthesia, surgery, or injections of medication for my child. Medical providers are authorized to disclose protected health information to the adult in charge and/or any physician or health care provider involved in providing medical care to the participant.
With appreciation of the dangers and risks associated with programs and activities including preparations for and transportation to and from the activity, on my own behalf and/or on behalf of my child, I hereby fully and completely release and waive any and all claims for personal injury, death, or loss that may arise against the organisation, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organisations associated with any program or activity.
my child being filmed or photographed during the activity, with the possibility that these photographs/media recordings may be used for publications or marketing publicity. Networks Indoor Cricket Centre will take all steps to ensure these images are used solely for the purposes for which they are intended.
I understand that my child needs to follow the behaviour code and any safety rules so that Networks Indoor Cricket Centre can keep them and other children safe.
I agree to (please tick):
*
“I agree.” Instead of a digital signature, this click represents the signature and indicates acceptance.
Date/Time
*
Submit